Active NPI
Angela Gordon Vick, M.ED, CCC-SLP
- Speech-Language Pathologist
- Leesburg, GA
National Provider Identifier
1174695019
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128a(1) exclusion effective Jul 20, 2021.
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP004869
- Practice address
- 244 Long Pine Dr
Leesburg, GA 31763-3175 - Phone
- (229) 395-9255
- NPI assigned
- Nov 15, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLP004869 | GA | Primary |
Addresses
Primary practice location
244 Long Pine Dr
Leesburg, GA 31763-3175
Mailing address
244 Long Pine Dr
Leesburg, GA 31763-3175
Phone (229) 395-9255
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP004869 | GA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174695019",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "244 LONG PINE DR",
"city": "LEESBURG",
"state": "GA",
"postal_code": "317633175",
"telephone_number": "229-395-9255"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "244 LONG PINE DR",
"city": "LEESBURG",
"state": "GA",
"postal_code": "317633175",
"telephone_number": "229-395-9255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VICK",
"first_name": "ANGELA",
"middle_name": "GORDON",
"credential": "M.ED, CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "SLP004869",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Leesburg, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.